"You may get a single patient refund request and so the doctor tends to just accept it and repay the $70. But Medicare may take that as an admission of guilt and ask you to repay for every time you used that code in the past three years," she says. "You have to look at that claim and appeal it if you can, rather than just sending a check to be done with it."
In her book Medical Billing Horror Stories, Hollander details such incidents, including one physician who was dunned for overpayment on a single claim and paid it, only to have the auditors extrapolate the same code overcharge for the past seven years. The practice ended up paying $100,000 back to Medicare.
Documentation is the key to avoiding that kind of extrapolation disaster, Azia says. You should document well all the time, of course, but when asked for documentation for a sample of claims, take the time to provide thorough documentation on the front end. If you skimp on justifying that first batch of sample claims, you could jeopardize the validity of a much larger number of claims, he says.
"Don't neglect the petty little things in documentation" Azia cautions. "We've seen claims thrown out because they weren't signed, the date was wrong, or even because the signature was illegible. These contractors are looking for technical errors that allow them to put this claim in the fraudulent column. It's a game of 'gotcha' they play sometimes, and even if you win those on appeal, it's a headache."